Percutaneous endoscopic gastrostomy in children with cancer

We reviewed the clinical course of 32 children with cancer who received nut rition through a feeding tube placed percutaneously during gastroscopy (PEG ). Their median age was 5.1 y (75%, range: 1.8-13.7 y, min: 3.5 mo) when th e PEG was done 0.7-23 mo after diagnosis (median: 1.8 mo, 75%; range: 0.9-8 mo). Five of the children underwent bone marrow transplantation with the g astrostomy in place. There was a significant (p = 0.0001) decrease in the m edian weight-for-age SDS of 0.55 (75%, range: -1.18-0.28) from the time of diagnosis to placement of the gastrostomy. Twenty-two percent of the childr en had neutrophils <0.5 x 10(9)/l at the time of placement. There were no m ajor postoperative complications. Seventy-two percent of the patients exper ienced a total of 55 minor and transient complications including leakage of gastric juice (n = 29), superficial wound infections (n = 23), mechanical problems (n = 2), or bleeding (n = 1). There were no documented cases of ba cteraemia. Twelve of the wound infections (52%) arose during neutropenic ep isodes. Two tubes were replaced due to mechanical problems. There was a med ian increase in weight SDS of 0.3 (75%, range: -0.6-1.1) from the time of p lacing the gastrostomy to the end of follow-up (p = 0.054). Nutrition via g astrostomy in children with cancer has several advantages. It is rarely ass ociated with more than minor complications, it is cosmetically more accepta ble than the nasogastric tube and it improves nutrition at far lower cost t han parenteral nutrition. In selected cases in which bone marrow transplant ation or intensive treatment protocols are planned, we suggest that a gastr ostomy should be considered before malnutrition develops.